Long-acting Reversible Contraception Among Homeless Women Veterans With Chronic Health Conditions

Abstract

Background U.S. women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long acting reversible contraceptives (LARC) can assist in healthy pregnancy planning. Objectives To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans. Research Design A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002–2015. Subjects We included 41,747 ever-homeless Women Veterans age 18–44y and 46,391 housed women Veterans matched by military service period. A subgroup of 7,773 ever-homeless and 8,674 matched housed women Veterans deployed in Iraq and Afghanistan (OEF/OIF/OND) conflicts comprised a second analytic cohort. Measures Descriptive statistics compared demographic, military, health conditions, and LARC exposure in ever-homeless vs. housed women Veterans. Multivariable logistic regression explored factors associated with LARC exposure in the OEF/OIF/OND subgroup. Results All health conditions were significantly higher in ever-homeless vs. housed Veterans: mental health disorder in 84.5% vs. 48.7% (p<0.001), substance abuse in 35.8% vs. 8.6% (p<0.001), and medical conditions in 74.7% vs. 55.6% (p<0.001). LARC exposure among all VHA users was 9.3% in ever-homeless Veterans vs. 5.4% in housed Veterans (p<0.001). LARC exposure in the OEF/OIF/OND cohort was 14.1% in ever-homeless Veterans vs. 8.2% in housed Veterans (p<0.001). In the OEF/OIF/OND cohort, homelessness along Veterans with medical and mental health indicators were leading LARC exposure predictors. Conclusions The VHA is successfully engaging homeless women Veterans and providing LARC access. The prevalence of perinatal risk factors in ever-homeless women Veterans highlights a need for further programmatic enhancements to improve reproductive planning.

Contraceptive usage in homeless women accessing a dedicated primary care service in Scotland, UK: a case note review

“…LARC use in this group is high compared with the general population, with over one in four of all women using LARC as their main method of contraception, compared with one in twenty in the general Scottish population of women of similar age (13). Studies in the homeless population in the US concur that LARC use in homeless women is also considerable; 29% use in ever homeless women in Los Angeles and 14% in ever homeless US veterans compared with 8% if housed (6,7,8). This may be due to specific programmes/subsidies targeting these groups and as previously stated, it is unlikely that US and UK data is directly comparable.…”

“…The implant was also the most common LARC used in a UK programme for women who had repeatedly had children taken into care (23). Previous studies in the homeless population in the US have shown a preference for intrauterine contraception but data is limited (6,7,8). Given implants were performed on site at the Edinburgh Access Practice, provider training and patient familiarity with the setting may have influenced this result.…”

“…Implications for further research, policy and practice There is a dearth of quantitative data on contraceptive usage for women experiencing homelessness (5,6,7,8). This study adds to that limited data but a more comprehensive picture is required.…”

“…Studies in the United States of America (USA) report that there are very limited contraceptive services for women experiencing homelessness (5) and that these women may be more likely to use long acting reversible contraception (LARC) than the general population (6,7,8). UK and US contraception data is not directly comparable.…”

Contraceptive Care in the Veterans Health Administration

“…21 Finally, homelessness has previously been associated with low rates of contraceptive use and inconsistent use of reproductive health care. 22,23 The underlying causes of associations between these social and health factors and contraceptive use patterns are not yet completely understood, but could include differential access to healthcare and to the full range of contraceptive methods, knowledge, and attitudes about contraception and pregnancy, and/or interactions with the healthcare system.…”